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SECTION I - VESTING INFORMATION (Must be stated in bylaws) <br />Years of service with fire department required for full vesting 20 <br />Years of active membership in the relief association required for full vesting 70 <br />Minimum retirement age to receive benefits SO <br />Minimum years as active member of relief association 0 <br />Early vesting provision in bylaws? Y < N <br />SECTION 2 - BENEFIT INFORMATION <br />A. FOR DEFINED BENEFIT -LUMP SUM PLANS ONLY... <br />Benefit payable for each year of service $ % 4) <br />*** GO TO SECTION 3*** <br />B. FOR MONTHLYBENEFIT PLANS ONLY... <br />Date of Most Recent Actuarial Valuation <br />Date Filed with State Auditor <br />Benefit payable for each month of service $ <br />You must attach as actuarial report, if the report was prepared this year. M actuarial report must be prepared everyfourth year. An actuarial update <br />must be prepared each time you increase your benefit. <br />*** GO TO SECTION 3*** <br />C. FOR DEFINED CONTRIBUTION PLANS ONLY... <br />Non -investment income per active member <br />Investment income per dollar of assets <br />You must attach an allocation table which lists the name of each member, the beginning account balance for each account, allocations to each account for <br />1994, and ending account balance. See instructions for statutory requirements on the allocation of income. You may use the optional allocation table <br />attached to the instructions or your own form. <br />*** GO TO SECTION 3*** <br />SECTION 3 - SUPPLEMENTAL INFORMATION <br />Is the secretary of the relief association bonded? Y N x Amount <br />Is the treasurer of the relief association bonded? Y n N Amount 4U ockJ <br />Is the treasurer bonded for at least 10% of the assets, as required by § 69,051? Yam_ N <br />Have you amended your bylaws in 1994? Y N_ C (If you answered "YES" to this question, you must attach a copy to this report) <br />Have you increased/changed your benefits since 12/31/93? Y i` N_th(If you answered "YES" to this question, you must attach a copy o£ <br />your city council ratification or independent non-profit board resolution that approves e increase or change) <br />SECTION 4 - INVESTMENT INFORMATION (At market value) <br />PLEASE ROUND OFF ALL AMOUNTS TO THE NEAREST DOLLAR <br />Cash (Demand Deposits) <br />Certificates of Deposit (time deposits) <br />Money Market Accounts <br />Treasury Bonds and Hills <br />Common Stocks - <br />Mutual Funds (list names in box or attach list) <br />MSRS Fund <br />Iorporate Bonds <br />Other (list tames in box or attach list) <br />TOTAL PIVESfMENTS <br />Special Fund <br />$ 1'3nP"d <br />$ 253, say <br />$ 3Z 1 530 <br />General Food <br />Please list mutual funds/other funds and their values <br />in this box. <br />See. �4t�+z�aQ <br />M141L/L' /1lu�ual 6AA $ ZS3,52y <br />141'/$ <br />